N.J. Admin. Code § 11:6-2.11 - WCMCO fraud detection plan
(a)
The WCMCO shall establish and implement a comprehensive fraud detection plan
for identifying and reporting instances of possible fraud on the part of
injured workers, employers, medical providers and others.
(b) The WCMCO fraud detection plan shall
consist of a written plan that is reviewed at least annually and revised as
necessary, and which shall include, but not be limited to:
1. Identification of items that trigger
investigation into fraud and abuse;
2. Identification of frequent fraud areas and
methods for detecting fraud;
3.
Mechanisms for receiving input on worker , employer and provider problems and
concerns regarding fraud or abuse; and
4. Procedures for investigating and reporting
suspected fraud.
(c) The
WCMCO shall coordinate its fraud detection plan with the workers' compensation
insurer 's fraud prevention plan, where appropriate.
Notes
See: 35 New Jersey Register 3541(a), 36 New Jersey Register 520(a).
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